W5: Headaches Flashcards
How many types of primary headaches are there? Name them.
Migrane (Vascular origin)
Cluster (Vascular origin)
Tension-type (Muscular origin)
Other
Prevalence and definition of a secondary headache
18%
Headache in close temporal relation to another disorder (ie another condition causes pain in the head or neck)
Name types of secondary headaches
Trauma related headache eg whiplash/concussion
Cervicogenic headache (related to neck pain)
Medication overuse headache
Headache related to an intercranial neoplasma, HTN or fasting
Trigeminal neuralgia (nerve pain that affects the face)
Other: Caffeine withdrawal or exercise/exertion headache
How many different headache disorders are there?
Lifetime prevalence?
…. leading causing of years lived with disability world-wide?
200 +
65-90%
2nd
What is a migraine?
Chronic neurological disorder characterized by moderate or severe headache (Note: the neurological and systemic symptoms are reversible).
Key symptoms of migraine?
Photophobia (eyes are sensitive to light)
Phonophobia (fear of loud sounds - can commonly trigger symptoms)
Nausea
Vertigo
Dizziness
Tinnitus
Migraine percentages:
- Unilateral
- Aggravated by PA
- Accompanying neck pain
60% unilateral
90% aggravated by PA
75% accompanied by neck pain
Migraine:
1 year prevalence
Female vs male
12% 1 year prevalence (high prev in Aus & East Europe)
Female 18%
Male 6%
Define a tension headache
Featureless headache that is characterized by nothing more than a pain in the head, assuming that some kind of mental or muscular tension might have a causative role
Tension headache
Cause?
Unilateral/bilateral?
Lifetime prevalence?
Unknown
Bilateral
79%
Cause is uncertain
Tightened muscles, Temporomandibular disorders, sleep problems or Stress?
What is a cervicogenic headache?
Headache results from cervical spine (referred pain)
Characteristics of cervicogenic headache?
- Headache associated with cervical stiffness
- Mostly unilateral
Cervicogenic headache: males vs females?
Female / male : 4 / 1
C0-C3 rotation and flexion/extension % of movement?
- 60% of all rotation
- 33% of all flexion/extension
Where is the prevalence of tension-type headaches high?
South America (moderate in Aus)
Redflags to observe in headache patients? DIAGRAM
- Rapid onset of symptoms (consider TIA, sinus venous, thrombosis)
- Thunderclap headache
- Presence of neurologic symptoms and signs
- Prominent neck pain with or without fever (consider meningitis, lumbar puncture, etc)
- Age at onset >50 (giant cell arthritis, intracranial tumour, HTN)
- Worsening with positional changes or valsalva maneuver
- New or worsening headache in patient with history of migraine
Headache red flags (MC Notes). 6 Ps + MORE
- 65 years
- Pattern change
- Sudden onset
- Papilledema (swelling of optic discs in the eye)
- HA due to coughing, sneezing, exercise
- Positional HA
- Pathology of immune system (HIV)
- Atypical presentation
- History of malignancies
- Systemic symptoms + fever
- Pregnancy
- Neurological deficit (consciousness)
- Painful eye
- Posttraumatic onset
Prognostic/diagnostic factors for migraine
Unilateral
Nausea/vomitting
Aggravated by PA
Prognostic/diagnostic factors for cervicogenic headache
Unilateral
Aggravation by head movements
Prognostic/diagnostic factors for medication overuse?
Family history
Prognostic/diagnostic factors for tension-type headache?
Bilateral
No Nausea
No aggravation
Physical examine for a headache?
- Postural assessment
- Active Range of Motion (1st image)
- Neck Flexion strength test (below image)
- Craniocervical flexion test (CCT) - uses the biofeedback cuff to assess deep neck flexors
- Passive accessory intervertebral movements (PAIVM) for C0-C3
- (Cervical) Flexion Rotation Test (CFRT)
- Check temporomandibular joints
Note: the cervical flexion rotation test is when the examiner passively positions the patient’s neck into full flexion to pre-tension the structures of the middle and lower cervical spine, then the patient’s head is passively rotated each direction while the flexed position is maintained.
Two key exams to assess in a cervicogenic headache?
Active ROM (generally reduced)
Flex Rot Test
For a migraine does acupuncture have effectiveness?
YES
Cochrane review found it was moderately beneficial
For a migraine does exercise have effectiveness?
YES
Meta-analysis found a statistically significant reduction of 0.6 headache day/month
What other treatments can be used for acute and preventative migraines?
Acute: medication (beware of medication overuse headache)
Preventative:
- Medication
- Behavioural techniques (relaxation training, cognitive behavioural therapy)
- Complementary medicine (tuina - chinese therapeutic massage, cupping, mindfulness, yoga), lifestyle (eating, sleeping, smoking) & acupuncture
Article: Meta-analysis on the effectiveness of physiotherapy on headache intensity, frequency, duration and QOL of patients with tension-type headache?
Findings??
Transcutaneous electrical stimulation combined with physiotherapy was the most effective approach to reduce pain intensity compared to control
Manual therapy (joint mobilisation) plus exercise was the most effective intervention to reduce headache frequency compared to control
Effectiveness of manual therapy for chronic tension-type headache? RCT.
Findings at 8 weeks vs 26 weeks?
After 8 weeks and 26 weeks a significantly larger reduction of headache frequency was found for the MT group
Disability and cervical function showed significant differences in favour of the MT group at 8 weeks but were not significantly different at 26 weeks.
**Mean difference about 6-6.5 headache days at 8 and 26 weeks
What other treatments can be used for acute and preventative tension-type headaches?
Acute: paracetamol
Treatment: Behavioural technique: relaxation training, CBT
TENS (moderate certainty of small effect)
Joint mobilisation + exercise (moderate certainty of small effect)
Article: Are non-invasive interventions effective for the management of headaches associated with neck pain.
Findings?
The management of headaches associated with neck pain should include exercise
Patients with cervicogenic headache may also benefit from a course of manual therapy
Medication overuse headache. Systematic review findings?
- We found low to very low level quality of evidence of no benefit of prednisone, prophylaxis, and withdrawal.
- Personalized (inpatient) approach seems beneficial over outpatient approach: 2-18 less days with medication use
- Behavioral: unclear results of relaxation
